A novel diagnostic tool for chronic obstructive eustachian tube dysfunction—the eustachian tube score

Abstract

Objectives/hypothesis: The purpose of this study was to introduce a new tool for the diagnosis of chronic obstructive eustachian tube dysfunction (ETD) and as a follow-up tool for eustachian tube therapy using objective and subjective elements.

Study design: Combined, prospective, retrospective clinical study at a tertiary referral center.

Methods: Physical examination, history, tympanometry, audiometry, and tubomanometry as well as the seven-item Eustachian Tube Dysfunction Questionnaire (EDTQ-7) were included as diagnostic tests. After initiating the eustachian tube score (ETS), we compared our results of healthy subjects to our data of patients with chronic obstructive ETD. In addition to ETS, an extended test ETS-7 was evaluated, which incorporated two additional items.

Results: The test-retest reliability revealed a correlation of 0.82 for the ETS and 0.87 for the ETS-7. ETS-7 receiver operating characteristic analysis, with reference to the EDTQ-7 score, resulted in an area under the curve (AUC) of 0.64. Our analysis considered essential criteria of ETD as comparative tools, which were typical clinical complaints, and at least two of three conditions: a pathologic EDTQ-7, a type B/C tympanometry, and a positive independent expert evaluation. The corresponding AUC was 0.98. Chronic obstructive ETD was identified at a cutoff of 7, with a sensitivity of 96% and a specificity of 96%, using the novel ETS-7.

Conclusions: ETS is a valid and reliable instrument in adult patients with chronic obstructive ETD. ETS-7, with a cutoff point of ≤7, should facilitate the diagnosis of ETD and might be valuable as a diagnostic follow-up tool.

Keywords: Eustachian Tube Dysfunction Questionnaire-7; Eustachian tube; eustachian tube score; tubomanometry.